Human breast cancer specimens: diffraction-enhanced imaging with histologic correlation--improved conspicuity of lesion detail compared with digital radiography

T staging esophageal tumors with x rays

With histopathology results typically taking several days, the ability to stage tumors during interventions could provide a step change in various cancer interventions. X-ray technology has advanced significantly in recent years with the introduction of phase-based imaging methods. These have been adapted for use in standard labs rather than specialized facilities such as synchrotrons, and approaches that enable fast 3D scans with conventional x-ray sources have been developed. This opens the possibility to produce 3D images with enhanced soft tissue contrast at a level of detail comparable to histopathology, in times sufficiently short to be compatible with use during surgical interventions. In this paper we discuss the application of one such approach to human esophagi obtained from esophagectomy interventions. We demonstrate that the image quality is sufficiently high to enable tumor T staging based on the x-ray datasets alone. Alongside detection of involved margins with potentially life-saving implications, staging tumors intra-operatively has the potential to change patient pathways, facilitating optimization of therapeutic interventions during the procedure itself. Besides a prospective intra-operative use, the availability of high-quality 3D images of entire esophageal tumors can support histopathological characterization, from enabling "right slice first time" approaches to understanding the histopathology in the full 3D context of the surrounding tumor environment.

Phase-contrast imaging with synchrotron hard X-ray reveals the effect of icariin on bone tissue morphology and microstructure in rabbits with early glucocorticoid-induced osteonecrosis of the femoral head

Background: Phase-contrast imaging (PCI) with synchrotron hard X-ray was used to observe the changes in bone tissue morphology and microstructure in rabbit models of early glucocorticoid-induced osteonecrosis of the femoral head (ONFH), and to evaluate the intervention effect of Icariin. Methods: Fifty mature New Zealand rabbits (weighing 2.5-3.0 kg) were randomly divided into a control group (n = 10), a glucocorticoid group (n = 20), and an Icariin group (n = 20). The glucocorticoid group and the Icariin group were sequentially injected with lipopolysaccharide (LPS) and methylprednisolone (MPS) to establish a glucocorticoid-induced ONFH animal model. The Icariin group was given Icariin solution when methylprednisolone was injected for the first time, and the control group and glucocorticoid group were given the same amount of normal saline. Animals were sacrificed after 6 weeks, and bilateral femoral head specimens were taken for research. The right femoral head was observed by PCI with synchrotron hard X-ray technology, and the left femoral head was verified by Micro-CT scanning and HE staining. Results: Forty-three animals (nine in the control group, sixteen in the glucocorticoid group, and eighteen in the Icariin group) were included in the study. PCI with synchrotron hard X-ray revealed that the trabecular bone in the glucocorticoid group was thinned, broken, and structurally damaged, whereas the trabecular bone in the Icariin group had normal volume, thickness, and a relatively intact structure. Micro-CT scan reconstruction and HE staining were used to verify the reliability of this technique in identifying osteonecrosis. Conclusion: The effects of Icariin were observed in an early glucocorticoid-induced ONFH rabbit model using PCI with synchrotron hard X-ray. Icariin weakens the destructive effect of glucocorticoids on bone tissue structure, improves bone tissue morphology, and stabilizes bone microstructure. This technique may provide a definitive, non-invasive alternative to histological examination for the diagnosis of early ONFH.

Edge-illumination x-ray phase-contrast imaging

Although early demonstration dates back to the mid-sixties, x-ray phase-contrast imaging (XPCI) became hugely popular in the mid-90s, thanks to the advent of 3rd generation synchrotron facilities. Its ability to reveal object features that had so far been considered invisible to x-rays immediately suggested great potential for applications across the life and the physical sciences, and an increasing number of groups worldwide started experimenting with it. At that time, it looked like a synchrotron facility was strictly necessary to perform XPCI with some degree of efficiency-the only alternative being micro-focal sources, the limited flux of which imposed excessively long exposure times. However, new approaches emerged in the mid-00s that overcame this limitation, and allowed XPCI implementations with conventional, non-micro-focal x-ray sources. One of these approaches showing particular promise for 'real-world' applications is edge-illumination XPCI: this article describes the key steps in its evolution in the context of contemporary developments in XPCI research, and presents its current state-of-the-art, especially in terms of transition towards practical applications.

Development and preclinical evaluation of a patient-specific high energy x-ray phase sensitive breast tomosynthesis system

BACKGROUND

This article reports the first x-ray phase sensitive breast tomosynthesis (PBT) system that is aimed for direct translation to clinical practice for the diagnosis of breast cancer.

PURPOSE

To report the preclinical evaluation and comparison of the newly built PBT system with a conventional digital breast tomosynthesis (DBT) system.

METHODS AND MATERIALS

The PBT system is developed based on a comprehensive inline phase contrast theoretical model. The system consists of a polyenergetic microfocus x-ray source and a flat panel detector mounted on an arm that is attached to a rotating gantry. It acquires nine projections over a 15° angular span in a stop-and-shoot manner. A dedicated phase retrieval algorithm is integrated with a filtered back-projection method that reconstructs tomographic slices. The American College of Radiology (ACR) accreditation phantom, a contrast detail (CD) phantom and mastectomy tissue samples were imaged at the same glandular dose levels by both the PBT and a standard of care DBT system for image quality characterizations and comparisons.

RESULTS

The PBT imaging scores with the ACR phantom are in good to excellent range and meet the quality assurance criteria set by the Mammography Quality Standard Act. The CD phantom image comparison and associated statistical analyses from two-alternative forced-choice reader studies confirm the improvement offered by the PBT system in terms of contrast resolution, spatial resolution, and conspicuity. The artifact spread function (ASF) analyses revealed a sizable lateral spread of metal artifacts in PBT slices as compared to DBT slices. Signal-to-noise ratio values for various inserts of the ACR and CD phantoms further validated the superiority of the PBT system. Mastectomy sample images acquired by the PBT system showed a superior depiction of microcalcifications vs the DBT system.

CONCLUSION

The PBT imaging technology can be clinically employed for improving the accuracy of breast cancer screening and diagnosis.

Principles of Different X-ray Phase-Contrast Imaging: A Review

Numerous advances have been made in X-ray technology in recent years. X-ray imaging plays an important role in the nondestructive exploration of the internal structures of objects. However, the contrast of X-ray absorption images remains low, especially for materials with low atomic numbers, such as biological samples. X-ray phase-contrast images have an intrinsically higher contrast than absorption images. In this review, the principles, milestones, and recent progress of X-ray phase-contrast imaging methods are demonstrated. In addition, prospective applications are presented.

Detection of involved margins in breast specimens with X-ray phase-contrast computed tomography

Margins of wide local excisions in breast conserving surgery are tested through histology, which can delay results by days and lead to second operations. Detection of margin involvement intraoperatively would allow the removal of additional tissue during the same intervention. X-ray phase contrast imaging (XPCI) provides soft tissue sensitivity superior to conventional X-rays: we propose its use to detect margin involvement intraoperatively. We have developed a system that can perform phase-based computed tomography (CT) scans in minutes, used it to image 101 specimens approximately half of which contained neoplastic lesions, and compared results against those of a commercial system. Histological analysis was carried out on all specimens and used as the gold standard. XPCI-CT showed higher sensitivity (83%, 95% CI 69–92%) than conventional specimen imaging (32%, 95% CI 20–49%) for detection of lesions at margin, and comparable specificity (83%, 95% CI 70–92% vs 86%, 95% CI 73–93%). Within the limits of this study, in particular that specimens obtained from surplus tissue typically contain small lesions which makes detection more difficult for both methods, we believe it likely that the observed increase in sensitivity will lead to a comparable reduction in the number of re-operations.

X-ray dark-field phase-contrast imaging: Origins of the concept to practical implementation and applications

The basic idea of X-ray dark-field imaging (XDFI), first presented in 2000, was based on the concepts used in an X-ray interferometer. In this article, we review 20 years of developments in our theoretical understanding, scientific instrumentation, and experimental demonstration of XDFI and its applications to medical imaging. We first describe the concepts underlying XDFI that are responsible for imparting phase contrast information in projection X-ray images. We then review the algorithms that can convert these projection phase images into three-dimensional tomographic slices. Various implementations of computed tomography reconstructions algorithms for XDFI data are discussed. The next four sections describe and illustrate potential applications of XDFI in pathology, musculoskeletal imaging, oncologic imaging, and neuroimaging. The sample applications that are presented illustrate potential use scenarios for XDFI in histopathology and other clinical applications. Finally, the last section presents future perspectives and potential technical developments that can make XDFI an even more powerful tool.

Phase Contrast Imaging Based Microbubble Monitoring of Radiofrequency Ablation: An ex vivo Study

Background

To explore the potential of synchrotron radiation (SR) phase contrast imaging (PCI) for real-time microbubble formation monitoring during radiofrequency ablation (RFA).

Methods

RFA was performed on ex vivo porcine muscle tissue using unipolar and multi-tined expandable electrodes. Images of microbubble formation in the samples were captured by both SR PCI and absorption contrast imaging. The synchronous ablation temperature was recorded. Each RFA electrode type group contained 6 samples. Ablation size was assessed by histologic examination.

Results

Microbubble formation during RFA could be visualized by SR PCI. The diameter of the microbubbles revealed on the image ranged from tens of microns to several millimeters, and these microbubbles first appeared at the edge of the RFA electrode when the target region temperature reached approximately 60°C and rapidly extended outwards. The average microbubble range measured on PCI was 17.66 ± 0.74 mm. The average range of coagulation necrosis measured by histological examination was 17.22 ± 0.38 mm. There was no significant difference between them (P > 0.05). The range of microbubbles corresponded to the ablation zone.

Conclusion

PCI enabled real-time high-resolution visualization of microbubble formation during RFA, indicating a potential for its use in ablation monitoring.

Fast diffraction-enhanced imaging using continuous sample rotation and analyzer crystal scanning

Diffraction-enhanced imaging (DEI) has high sensitivity and a wide dynamic range of density and thus can be used for fine imaging of biological and organic samples that include large differences in density. A fast DEI method composed of continuous fast sample rotations and slow analyzer crystal scanning was developed to shorten the measurement period. Fine sectional images of a biological sample were successfully obtained within a half measurement period of the conventional step-scanning method while keeping the same exposure time. In addition, a fine three-dimensional image of a rat tail was obtained with a 375 s measurement period.

Discrimination analysis of breast calcifications using x-ray dark-field radiography

BACKGROUND

X-ray dark-field radiography could enhance mammography by providing more information on imaged tissue and microcalcifications. The dark field signal is a measure of small angle scattering and can thus provide additional information on the imaged materials. This information can be useful for material distinction of calcifications and the diagnosis of breast cancer by classifying benign and malign association of these calcifications.

METHODS

For this study, institutional review board approval was obtained. We present the evaluation of images acquired with interferometric grating-based x-ray imaging of 323 microcalcifications (166 malign and 157 benign associated) in freshly dissected breast tissue and compare the results to the information extracted in follow-up pathological evaluation. The number of imaged calcifications is sufficiently higher than in similar previous studies. Fourteen calcification properties were extracted from the digital images and used as predictors in three different models common in discrimination analysis namely a simple threshold model, a naive Bayes model and a linear regression model, which classify the calcifications as associated with a benign or suspicious finding. Three of these fourteen predictors have been newly defined in this work and are independent from the tissue background surrounding the microcalcifications. Using these predictors no background correction is needed, as in previous works in this field. The new predictors are the length of the first and second principle component of the absorption and dark-field data, as well as the angle between the first principle component and the dark-field axis. We called these predictors data length, data width, and data orientation.

RESULTS

In fourfold cross-validation malignancy of the imaged tissue was predicted. Models that take only classical absorption predictors into account reached a sensitivity of 53.3% at a specificity of 81.1%. For a combination of predictors that also include dark field information, a sensitivity of 63.2% and specificity of 80.8% were obtained. The included dark field information consisted of the newly introduced parameters, data orientation and data width.

CONCLUSIONS

While remaining at a similar specificity, the sensitivity, with which a trained model was able to distinguish malign from benign associated calcifications, was increased by 10% on including dark-field information. This suggests grating-based x-ray imaging as a promising clinical imaging method in the field of mammography.

Emerging Breast Imaging Technologies on the Horizon

Early detection of breast cancers by mammography in conjunction with adjuvant therapy has contributed to reduction in breast cancer mortality. Mammography remains the "gold-standard" for breast cancer screening but is limited by tissue superposition. Digital breast tomosynthesis and more recently, dedicated breast computed tomography have been developed to alleviate the tissue superposition problem. However, all of these modalities rely upon x-ray attenuation contrast to provide anatomical images, and there are ongoing efforts to develop and clinically translate alternative modalities. These emerging modalities could provide for new contrast mechanisms and may potentially improve lesion detection and diagnosis. In this article, several of these emerging modalities are discussed with a focus on technologies that have advanced to the stage of in vivo clinical evaluation.

Correlation of X-ray diffraction signatures of breast tissue and their histopathological classification

This pilot study examines the correlation of X-ray diffraction (XRD) measurements with the histopathological analysis of breast tissue. Eight breast cancer samples were investigated. Each sample contained a mixture of normal and cancerous tissues. In total, 522 separate XRD measurements were made at different locations across the samples (8 in total). The resulting XRD spectra were subjected to principal component analysis (PCA) in order to determine if there were any distinguishing features that could be used to identify different tissue components. 99.0% of the variation between the spectra were described by the first two principal components (PC). Comparing the location of points in PC space with the classification determined by histopathology indicated correlation between the shape/magnitude of the XRD spectra and the tissue type. These results are encouraging and suggest that XRD could be used for the intraoperative or postoperative classification of bulk tissue samples.

Noise properties and task-based evaluation of diffraction-enhanced imaging

Diffraction-enhanced imaging (DEI) is an emerging x-ray imaging method that simultaneously yields x-ray attenuation and refraction images and holds great promise for soft-tissue imaging. The DEI has been mainly studied using synchrotron sources, but efforts have been made to transition the technology to more practical implementations using conventional x-ray sources. The main technical challenge of this transition lies in the relatively lower x-ray flux obtained from conventional sources, leading to photon-limited data contaminated by Poisson noise. Several issues that must be understood in order to design and optimize DEI imaging systems with respect to noise performance are addressed. Specifically, we: (a) develop equations describing the noise properties of DEI images, (b) derive the conditions under which the DEI algorithm is statistically optimal,

Emerging clinical applications of computed tomography

X-ray computed tomography (CT) has recently been experiencing remarkable growth as a result of technological advances and new clinical applications. This paper reviews the essential physics of X-ray CT and its major components. Also reviewed are recent promising applications of CT, ie, CT-guided procedures, CT-based thermometry, photon-counting technology, hybrid PET-CT, use of ultrafast-high pitch scanners, and potential use of dual-energy CT for material differentiations. These promising solutions and a better knowledge of their potentialities should allow CT to be used in a safe and effective manner in several clinical applications.

Signs analysis and clinical assessment: phase-contrast computed tomography of human breast tumours

Purpose

To analyse the diagnostic signs present in slices of human breast tumour specimens using synchrotron radiation phase-contrast imaging computed tomography (PCI-CT) for the first time and assess the feasibility of this technique for clinical applications.

Materials and Methods

The ethics committee of our university and relevant clinical hospital approved this prospective study, and written informed consent was obtained from all patients. PCI-CT of human breast tumour specimens with synchrotron radiation was performed at the Shanghai Synchrotron Radiation Facility (SSRF). A total of 14 specimens of early-stage carcinomas and 8 specimens of adenomas were enrolled. Based on raw data reconstruction, the diagnostic signs present in the slices were analysed and correlated with histopathology. We proposed a criterion for clinical diagnosis according to the evaluated signs and the Breast Imaging Reporting and Data System (BI-RADS) for reference. The criterion was then assessed by clinicians in a double-blind method. Finally, descriptive statistics were evaluated, depending on the assessment results.

Results

The 14 carcinoma specimens and 8 adenoma specimens were diagnosed as malignant and benign tumours, respectively. The total coincidence rate was 100%.

Conclusion

Our study results demonstrate that the X-ray diagnostic signs observed in the specimen slices and the criterion used for clinical diagnosis were accurate and reliable. The criterion based on signs analysis can be used to differentiate early-stage benign or malignant tumours. As a promising imaging method, PCI-CT can serve as a possible and feasible supplement to BI-RADS in the future.

[Phase contrast imaging of the breast. Basic principles and steps towards clinical implementation]

CLINICAL/METHODICAL ISSUE

Breast cancer is the most common cancer and the leading cause of cancer deaths in women worldwide.

STANDARD RADIOLOGICAL METHODS

Mammography is the only imaging technique approved for nationwide breast cancer screening. Digital full field mammography has improved mammographic image quality. Nevertheless, mammography has a low positive predictive value and a low sensitivity especially in mammographically dense breasts. One of the major limitations is the inherently low contrast between healthy breast parenchyma and breast cancer.

METHODICAL INNOVATIONS

Phase contrast imaging is based on the phase shift that occurs when X-rays encounter a change in refractive index between different materials.

PERFORMANCE

The improved soft tissue contrast makes the technology particularly promising for breast diagnostics.

ACHIEVEMENTS

The studies presented here suggest that phase contrast imaging provides additional diagnostic information both using phase contrast mammography and phase contrast computed tomography (CT).

PRACTICAL RECOMMENDATIONS

This paper provides an overview of the basic principles of the phase contrast imaging and describes recent developments towards in vivo and ex vivo phase contrast imaging of the breast.

Large-angle x-ray scatter in Talbot-Lau interferometry for breast imaging

Monte Carlo simulations were used to investigate large-angle x-ray scatter at design energy of 25 keV during small field of view (9.6 cm × 5 cm) differential phase contrast imaging of the breast using Talbot-Lau interferometry. Homogenous, adipose and fibroglandular breasts of uniform thickness ranging from 2 to 8 cm encompassing the field of view were modeled. Theoretically determined transmission efficiencies of the gratings were used to validate the Monte Carlo simulations, followed by simulations to determine the x-ray scatter reaching the detector. The recorded x-ray scatter was classified into x-ray photons that underwent at least one Compton interaction (incoherent scatter) and Rayleigh interaction alone (coherent scatter) for further analysis. Monte Carlo based estimates of transmission efficiencies showed good correspondence [Formula: see text] with theoretical estimates. Scatter-to-primary ratio increased with increasing breast thickness, ranging from 0.11 to 0.22 for 2-8 cm thick adipose breasts and from 0.12 to 0.28 for 2-8 cm thick fibroglandular breasts. The analyzer grating reduced incoherent scatter by ~18% for 2 cm thick adipose breast and by ~35% for 8 cm thick fibroglandular breast. Coherent scatter was the dominant contributor to the total scatter. Coherent-to-incoherent scatter ratio ranged from 2.2 to 3.1 for 2-8 cm thick adipose breasts and from 2.7 to 3.4 for 2-8 cm thick fibroglandular breasts.

Diffraction-enhanced Synchrotron Imaging of Bovine Ovaries Ex Vivo

OBJECTIVES

The objective of this study was to test the hypothesis that diffraction-enhanced imaging (DEI), a synchrotron x-ray imaging technique, would provide greater contrast for evaluating bovine ovaries compared with conventional diagnostic ultrasonography.

MATERIALS AND METHODS

Bovine ovaries were evaluated ex vivo as follows: fresh without radiographic arterial contrast (n = 2), fresh with contrast (n = 1), preserved in 10% formalin without contrast (n = 2), and preserved with contrast (n = 1). Each ovary was imaged with DEI and subsequently with ultrasonography and histology. The ability to visualize and differentiate preantral and antral follicles, corpora lutea (CL), and cumulus oocyte complexes (COCs) were compared using DEI, ultrasonography, and histology. The diameter of follicles and CL were measured and compared using ultrasonography, DEI, and histology. The diameter of the smallest follicle detected was reported using each of the three imaging methods. The number of antral follicles (antral follicle count ≥2 mm) was compared between ultrasonography and DEI.

RESULTS

DEI enabled the detection of 71% of follicles and 67% of CL that were detected ultrasonographically. However, DEI did not allow the detection of COCs and cell layers of the follicle wall that were visualized histologically. Luteal tissues were not easily distinguished using DEI, and DEI was inferior for differentiating follicles and CL compared with ultrasonography. The mean follicle diameter was similar between DEI (4.00 ± 0.35 mm, fresh with contrast; 9.62 ± 2.43 mm, fresh without contrast) and ultrasonography (3.85 ± 0.28 mm, fresh with contrast; 8.97 ± 2.60 mm, fresh without contrast) (P > .05). However, the mean follicle diameter was greater using both DEI (4.00 ± 0.35 mm) and ultrasonography (3.85 ± 0.28 mm) compared with histology (2.21 ± 0.38 mm; P = .01, fresh ovaries with contrast). The mean CL diameter was similar between DEI (11.64 ± 1.67 mm), ultrasonography (9.34 ± 0.35 mm), and histology (9.59 ± 0.36 mm) (P > .05). The mean diameter of the smallest follicle detected was similar between DEI (3.06 ± 0.45 mm) and ultrasonography (2.95 ± 0.74 mm); both DEI and ultrasonographic measurements were greater than histology (0.39 ± 0.04 mm, P < .0001). The mean antral follicle count was similar between ultrasonography (6.50 ± 0.71 mm, fresh with no contrast; 6.50 ± 2.50 mm, preserved with no contrast) and DEI (4.50 ± 0.50 mm, fresh with no contrast; 6.50 ± 0.50 mm, preserved with no contrast) (P > .05).

CONCLUSIONS

The contrast resolution of antral follicles, CL, and COCs in bovine ovaries was inferior using DEI compared with ultrasonography and histology. Alternative synchrotron techniques, such as phase-contrast computed tomography and DEI computed tomography, may prove more effective than DEI for imaging ovaries ex vivo.

Limited-angle tomography for analyzer-based phase-contrast x-ray imaging

Multiple-image radiography (MIR) is an analyzer-based phase-contrast x-ray imaging method, which is emerging as a potential alternative to conventional radiography. MIR simultaneously generates three planar parametric images containing information about scattering, refraction and attenuation properties of the object. The MIR planar images are linear tomographic projections of the corresponding object properties, which allows reconstruction of volumetric images using computed tomography (CT) methods. However, when acquiring a full range of linear projections around the tissue of interest is not feasible or the scanning time is limited, limited-angle tomography techniques can be used to reconstruct these volumetric images near the central plane, which is the plane that contains the pivot point of the tomographic movement. In this work, we use computer simulations to explore the applicability of limited-angle tomography to MIR. We also investigate the accuracy of reconstructions as a function of number of tomographic angles for a fixed total radiation exposure. We use this function to find an optimal range of angles over which data should be acquired for limited-angle tomography MIR (LAT-MIR). Next, we apply the LAT-MIR technique to experimentally acquired MIR projections obtained in a cadaveric human thumb study. We compare the reconstructed slices near the central plane to the same slices reconstructed by CT-MIR using the full angular view around the object. Finally, we perform a task-based evaluation of LAT-MIR performance for different numbers of angular views, and use template matching to detect cartilage in the refraction image near the central plane. We use the signal-to-noise ratio of this test as the detectability metric to investigate an optimum range of tomographic angles for detecting soft tissues in LAT-MIR. Both results show that there is an optimum range of angular view for data acquisition where LAT-MIR yields the best performance, comparable to CT-MIR only if one considers volumetric images near the central plane and not the whole volume.

Quantitative breast tissue characterization using grating-based x-ray phase-contrast imaging

X-ray phase-contrast imaging has received growing interest in recent years due to its high capability in visualizing soft tissue. Breast imaging became the focus of particular attention as it is considered the most promising candidate for a first clinical application of this contrast modality. In this study, we investigate quantitative breast tissue characterization using grating-based phase-contrast computed tomography (CT) at conventional polychromatic x-ray sources. Different breast specimens have been scanned at a laboratory phase-contrast imaging setup and were correlated to histopathology. Ascertained tumor types include phylloides tumor, fibroadenoma and infiltrating lobular carcinoma. Identified tissue types comprising adipose, fibroglandular and tumor tissue have been analyzed in terms of phase-contrast Hounsfield units and are compared to high-quality, high-resolution data obtained with monochromatic synchrotron radiation, as well as calculated values based on tabulated tissue properties. The results give a good impression of the method's prospects and limitations for potential tumor detection and the associated demands on such a phase-contrast breast CT system. Furthermore, the evaluated quantitative tissue values serve as a reference for simulations and the design of dedicated phantoms for phase-contrast mammography.

Clinical boundary conditions for grating-based differential phase-contrast mammography

Research in grating-based differential phase-contrast imaging (DPCI) has gained increasing momentum in the past couple of years. The first results on the potential clinical benefits of the technique for X-ray mammography are becoming available and indicate improvements in terms of general image quality, the delineation of lesions versus the background tissue and the visibility of microcalcifications. In this paper, we investigate some aspects related to the technical feasibility of DPCI for human X-ray mammography. After a short introduction to state-of-the-art full-field digital mammography in terms of technical aspects as well as clinical aspects, we put together boundary conditions for DPCI. We then discuss the implications for system design in a comparative manner for systems with two-dimensional detectors versus slit-scanning systems, stating advantages and disadvantages of the two designs. Finally, focusing on a slit-scanning system, we outline a possible concept for phase acquisition.

Microcomputed tomography with diffraction-enhanced imaging for morphologic characterization and quantitative evaluation of microvessel of hepatic fibrosis in rats

Backgroud

Hepatic fibrosis can lead to deformation of vessel morphology and structure. In the present feasibility study, high-resolution computed tomography (CT) using diffraction-enhanced imaging (DEI) was used to represent three-dimensional (3D) vessel microstructures of hepatic fibrosis in rats and to differentiate different stages of hepatic fibrosis using qualitative descriptions and quantitative measurement of microvessels.

Material and Methods

Three typical specimens at different stages, i.e., mild, moderate and severe hepatic fibrosis, were imaged using DEI at 15 keV without contrast agents. The correspondence between DEI-CT images and histopathological findings was determined. The 3D visualizations from different stages of hepatic fibrosis were presented using DEI-CT. Additionally, Qualitative descriptions and quantitative evaluation of vessel features, such as vessel trend, vascular distortion deformation, thrombus formation and texture features on the inner wall of the vessel, were performed.

Results

DEI-CT produced high-resolution images of the vessel microstructures in hepatic fibrosis that corresponded to information on actual structures observed from the histological sections. Combined with the 3D visualization technique, DEI-CT enabled the acquisition of an accurate description of the 3D vessel morphology from different stages of hepatic fibrosis. Qualitative descriptions and quantitative assessment of microvessels demonstrated clear differences between the different stages of hepatic fibrosis. The thrombus inside the vessel of severe liver fibrosis was accurately displayed, and corresponding analysis can provide an exact measurement of vessel stenosis rate.

Conclusions

DEI-CT may allow morphologic descriptions and quantitative evaluation of vessel microstructures from different stages of hepatic fibrosis and can better characterize the various stages of fibrosis progression using high-resolution 3D vessel morphology.

X-ray phase contrast imaging of the breast: analysis of tissue simulating materials

PURPOSE

Phase contrast imaging, particularly of the breast, is being actively investigated. The purpose of this work is to investigate the x-ray phase contrast properties of breast tissues and commonly used breast tissue substitutes or phantom materials with an aim of determining the phantom materials best representative of breast tissues.

METHODS

Elemental compositions of breast tissues including adipose, fibroglandular, and skin were used to determine the refractive index, n = 1 - δ + i β. The real part of the refractive index, specifically the refractive index decrement (δ), over the energy range of 5-50 keV were determined using XOP software (version 2.3, European Synchrotron Radiation Facility, France). Calcium oxalate and calcium hydroxyapatite were considered to represent the material compositions of microcalcifications in vivo. Nineteen tissue substitutes were considered as possible candidates to represent adipose tissue, fibroglandular tissue and skin, and four phantom materials were considered as possible candidates to represent microcalcifications. For each material, either the molecular formula, if available, or the elemental composition based on weight fraction, was used to determine δ. At each x-ray photon energy, the absolute percent difference in δ between the breast tissue and the substitute material was determined, from which three candidates were selected. From these candidate tissue substitutes, the material that minimized the absolute percent difference in linear attenuation coefficient μ, and hence β, was considered to be best representative of that breast tissue.

RESULTS

Over the energy range of 5-50 keV, while the δ of CB3 and fibroglandular tissue-equivalent material were within 1% of that of fibroglandular tissue, the μ of fibroglandular tissue-equivalent material better approximated the fibroglandular tissue. While the δ of BR10 and adipose tissue-equivalent material were within 1% of that of adipose tissue, the tissue-equivalent material better approximated the adipose tissue in terms of μ. Polymethyl methacrylate, a commonly used tissue substitute, exhibited δ greater than fibroglandular tissue by ≈ 12%. The A-150 plastic closely approximated the skin. Several materials exhibited δ between that of adipose and fibroglandular tissue. However, there was an energy-dependent mismatch in terms of equivalent fibroglandular weight fraction between δ and μ for these materials. For microcalcifications, aluminum and calcium carbonate were observed to straddle the δ and μ of calcium oxalate and calcium hydroxyapatite. Aluminum oxide, commonly used to represent microcalcifications in the American College of Radiology recommended phantoms for accreditation exhibited δ greater than calcium hydroxyapatite by ≈ 23%.

CONCLUSIONS

A breast phantom comprising A-150 plastic to represent the skin, commercially available adipose and fibroglandular tissue-equivalent formulations to represent adipose and fibroglandular tissue, respectively, was found to be best suited for x-ray phase-sensitive imaging of the breast. Calcium carbonate or aluminum can be used to represent microcalcifications.

The meaning of interior tomography

The classic imaging geometry for computed tomography is for the collection of un-truncated projections and the reconstruction of a global image, with the Fourier transform as the theoretical foundation that is intrinsically non-local. Recently, interior tomography research has led to theoretically exact relationships between localities in the projection and image spaces and practically promising reconstruction algorithms. Initially, interior tomography was developed for x-ray computed tomography. Then, it was elevated to have the status of a general imaging principle. Finally, a novel framework known as 'omni-tomography' is being developed for a grand fusion of multiple imaging modalities, allowing tomographic synchrony of diversified features.

Optimization of analyzer-based imaging systems for minimal surface absorbed dose

Analyzer-based imaging has improved tissue X-ray imaging beyond what conventional radiography was able to achieve. The extent of the improvement is dependent on the crystal reflection used in the monochromator and analyzer combination, the imaging photon energy, the geometry of the sample and the imaging detector. These many factors determine the ability of the system to distinguish between various bone tissues or soft tissues with a specified statistical certainty between pixels in a counting detector before any image processing. The following discussion will detail changes in the required number of imaging photons and the resulting surface absorbed dose when the imaging variables are altered. The process whereby the optimal imaging parameters to deliver the minimum surface absorbed dose to a sample while obtaining a desired statistical certainty between sample materials for an arbitrary analyzer-based imaging system will be described. Two-component samples consisting of bone and soft tissue are discussed as an imaging test case. The two-component approach will then be generalized for a multiple-component sample.

Evaluation of phase-contrast CT of breast tissue at conventional X-ray sources - presentation of selected findings

BACKGROUND

Grating-based phase contrast computed tomography (PC-CT) at synchrotron radiation sources has been shown to provide improved visualization of breast tumors. However, broad clinical application of phase-contrast imaging will likely depend on transferring the technology to standard polychromatic X-ray sources. On the basis of selected findings, we demonstrate the potential of grating-based PC-CT using a conventional X-ray source.

MATERIALS AND METHODS

Grating-based PC-CT of two ex-vivo formalin fixed breast specimens containing lobular carcinoma was conducted using a Talbot Lau interferometer run at a polychromatic X-ray source of 40kVp. Phase-contrast and absorption-based 3D-datasets of both specimens were simultaneously recorded. Radiological images were manually matched with corresponding histological sections. The visualization of selected histological findings in phase contrast was compared to absorption contrast.

RESULTS

Grating-based PC-CT was able to depict the 3-dimensional structure of dilated ducts and high phase contrast was found as a correlate to thickened fibrous ductal walls. Differences in contrast between fibrous and less fibrous breast tissue were observed in phase- but not in absorption-contrast images. Furthermore, regions of low phase contrast correlated with the extension of compact tumor components.

CONCLUSIONS

On the basis of selected findings, we show that grating-based PC-CT at a polychromatic X-ray source provides complementary information to conventional absorption contrast; albeit at lower spatial resolution than synchrotron-based imaging.

X-ray phase-contrast imaging: from pre-clinical applications towards clinics

Phase-contrast x-ray imaging (PCI) is an innovative method that is sensitive to the refraction of the x-rays in matter. PCI is particularly adapted to visualize weakly absorbing details like those often encountered in biology and medicine. In past years, PCI has become one of the most used imaging methods in laboratory and preclinical studies: its unique characteristics allow high contrast 3D visualization of thick and complex samples even at high spatial resolution. Applications have covered a wide range of pathologies and organs, and are more and more often performed in vivo. Several techniques are now available to exploit and visualize the phase-contrast: propagation- and analyzer-based, crystal and grating interferometry and non-interferometric methods like the coded aperture. In this review, covering the last five years, we will give an overview of the main theoretical and experimental developments and of the important steps performed towards the clinical implementation of PCI.

Ideal-observer detectability in photon-counting differential phase-contrast imaging using a linear-systems approach

PURPOSE

To provide a cascaded-systems framework based on the noise-power spectrum (NPS), modulation transfer function (MTF), and noise-equivalent number of quanta (NEQ) for quantitative evaluation of differential phase-contrast imaging (Talbot interferometry) in relation to conventional absorption contrast under equal-dose, equal-geometry, and, to some extent, equal-photon-economy constraints. The focus is a geometry for photon-counting mammography.

METHODS

Phase-contrast imaging is a promising technology that may emerge as an alternative or adjunct to conventional absorption contrast. In particular, phase contrast may increase the signal-difference-to-noise ratio compared to absorption contrast because the difference in phase shift between soft-tissue structures is often substantially larger than the absorption difference. We have developed a comprehensive cascaded-systems framework to investigate Talbot interferometry, which is a technique for differential phase-contrast imaging. Analytical expressions for the MTF and NPS were derived to calculate the NEQ and a task-specific ideal-observer detectability index under assumptions of linearity and shift invariance. Talbot interferometry was compared to absorption contrast at equal dose, and using either a plane wave or a spherical wave in a conceivable mammography geometry. The impact of source size and spectrum bandwidth was included in the framework, and the trade-off with photon economy was investigated in some detail. Wave-propagation simulations were used to verify the analytical expressions and to generate example images.

RESULTS

Talbot interferometry inherently detects the differential of the phase, which led to a maximum in NEQ at high spatial frequencies, whereas the absorption-contrast NEQ decreased monotonically with frequency. Further, phase contrast detects differences in density rather than atomic number, and the optimal imaging energy was found to be a factor of 1.7 higher than for absorption contrast. Talbot interferometry with a plane wave increased detectability for 0.1-mm tumor and glandular structures by a factor of 3-4 at equal dose, whereas absorption contrast was the preferred method for structures larger than ∼0.5 mm. Microcalcifications are small, but differ from soft tissue in atomic number more than density, which is favored by absorption contrast, and Talbot interferometry was barely beneficial at all within the resolution limit of the system. Further, Talbot interferometry favored detection of "sharp" as opposed to "smooth" structures, and discrimination tasks by about 50% compared to detection tasks. The technique was relatively insensitive to spectrum bandwidth, whereas the projected source size was more important. If equal photon economy was added as a restriction, phase-contrast efficiency was reduced so that the benefit for detection tasks almost vanished compared to absorption contrast, but discrimination tasks were still improved close to a factor of 2 at the resolution limit.

CONCLUSIONS

Cascaded-systems analysis enables comprehensive and intuitive evaluation of phase-contrast efficiency in relation to absorption contrast under requirements of equal dose, equal geometry, and equal photon economy. The benefit of Talbot interferometry was highly dependent on task, in particular detection versus discrimination tasks, and target size, shape, and material. Requiring equal photon economy weakened the benefit of Talbot interferometry in mammography.

Visualising liver fibrosis by phase-contrast X-ray imaging in common bile duct ligated mice

OBJECTIVES

To determine whether phase-contrast X-ray imaging can be used to visualise directly the accumulated extracellular matrix proteins associated with liver fibrosis in common bile duct ligated mice.

METHODS

Twenty-six-week-old C57BL female mice were randomised into three groups. In groups 1 (n = 5) and 2 (n = 10), common bile duct ligation was conducted to produce secondary biliary cirrhosis. Mouse livers were then excised 15 (group 1) and 40 days (group 2) after the ligation of the common bile duct for imaging. In the control group, the livers of 5 mice were excised 40 days after the sham operation. Images were then acquired using the analyser crystal set at different positions of the rocking curve.

RESULTS

The results show that the fibrotic septa and hepatic lobules enclosed by fibrotic septa can be visualised clearly at the whole organ level via phase-contrast X-ray imaging without any contrast agent.

CONCLUSION

These results suggest that phase-contrast X-ray imaging can easily reveal the accumulated extracellular matrix proteins associated with liver fibrosis without using any contrast agent and has great potential in the study of liver fibrosis.

Comparative study of the value of dual tracer PET/CT in evaluating breast cancer

The present study was conducted to assess the relationship between tumor uptake and pathologic findings using dual-tracer PET/computed tomography (CT) in patients with breast cancer. Seventy-four patients with breast cancer (mean age 54 years) who underwent (11)C-choline and 2-[(18)F]fluoro-2-deoxy-d-glucose ((18)F-FDG) PET/CT prior to surgery on the same day were enrolled in the present study. Images were reviewed by a board-certified radiologist and two nuclear medicine specialists who were unaware of any clinical information and a consensus was reached. Uptake patterns and measurements of dual tracers were compared with the pathologic findings of resected specimens as the reference standard. Mean (±SD) tumor size was 5.9 ± 3.2 cm. All primary tumors were identified on (18)F-FDG PET/CT and (11)C-choline PET/CT. However, (18)F-FDG PET/CT demonstrated focal uptake of the primary tumor with (n = 38; 51%) or without (n = 36; 49%) diffuse background breast uptake. Of the pathologic findings, multiple logistic regression analysis revealed an independent association between fibrocystic change and diffuse background breast uptake (odds ratio [OR] 8.57; 95% confidence interval [CI] 2.86-25.66; P < 0.0001). Tumors with higher histologic grade, nuclear grade, structural grade, nuclear atypia, and mitosis had significantly higher maximum standardized uptake values (SUV(max)) and tumor-to-background ratios (TBR) for both tracers. Multiple logistic regression analysis revealed that only the degree of mitosis was independently associated with a high SUV(max) (OR 7.45; 95%CI 2.21-25.11; P = 0.001) and a high TBR (OR 5.41; 95%CI 1.13-25.96; P = 0.035) of (11)C-choline PET/CT. In conclusion, (11)C-choline may improve tumor delineation and reflect tumor aggressiveness on PET/CT in patients with breast cancer.

Multimodal hard X-ray imaging of a mammography phantom at a compact synchrotron light source

The Compact Light Source is a miniature synchrotron producing X-rays at the interaction point of a counter-propagating laser pulse and electron bunch through the process of inverse Compton scattering. The small transverse size of the luminous region yields a highly coherent beam with an angular divergence of a few milliradians. The intrinsic monochromaticity and coherence of the produced X-rays can be exploited in high-sensitivity differential phase-contrast imaging with a grating-based interferometer. Here, the first multimodal X-ray imaging experiments at the Compact Light Source at a clinically compatible X-ray energy of 21 keV are reported. Dose-compatible measurements of a mammography phantom clearly demonstrate an increase in contrast attainable through differential phase and dark-field imaging over conventional attenuation-based projections.

High-resolution breast tomography at high energy: a feasibility study of phase contrast imaging on a whole breast

Previous studies on phase contrast imaging (PCI) mammography have demonstrated an enhancement of breast morphology and cancerous tissue visualization compared to conventional imaging. We show here the first results of the PCI analyser-based imaging (ABI) in computed tomography (CT) mode on whole and large (>12 cm) tumour-bearing breast tissues. We demonstrate in this work the capability of the technique of working at high x-ray energies and producing high-contrast images of large and complex specimens. One entire breast of an 80-year-old woman with invasive ductal cancer was imaged using ABI-CT with monochromatic 70 keV x-rays and an area detector of 92×92 µm² pixel size. Sagittal slices were reconstructed from the acquired data, and compared to corresponding histological sections. Comparison with conventional absorption-based CT was also performed. Five blinded radiologists quantitatively evaluated the visual aspects of the ABI-CT images with respect to sharpness, soft tissue contrast, tissue boundaries and the discrimination of different structures/tissues. ABI-CT excellently depicted the entire 3D architecture of the breast volume by providing high-resolution and high-contrast images of the normal and cancerous breast tissues. These results are an important step in the evolution of PCI-CT towards its clinical implementation.

In vivo physiological saline-infused hepatic vessel imaging using a two-crystal-interferometer-based phase-contrast X-ray technique

Using a two-crystal-interferometer-based phase-contrast X-ray imaging system, the portal vein, capillary vessel area and hepatic vein of live rats were revealed sequentially by injecting physiological saline via the portal vein. Vessels greater than 0.06 mm in diameter were clearly shown with low levels of X-rays (552 µGy). This suggests that in vivo vessel imaging of small animals can be performed as conventional angiography without the side effects of the presently used iodine contrast agents.

Diffraction enhanced imaging of a rat model of gastric acid aspiration pneumonitis

RATIONALE AND OBJECTIVES

Diffraction-enhanced imaging (DEI) is a type of phase contrast x-ray imaging that has improved image contrast at a lower dose than conventional radiography for many imaging applications, but no studies have been done to determine if DEI might be useful for diagnosing lung injury. The goals of this study were to determine if DEI could differentiate between healthy and injured lungs for a rat model of gastric aspiration and to compare diffraction-enhanced images with chest radiographs.

MATERIALS AND METHODS

Radiographs and diffraction-enhanced chest images of adult Sprague Dawley rats were obtained before and 4 hours after the aspiration of 0.4 mL/kg of 0.1 mol/L hydrochloric acid. Lung damage was confirmed with histopathology.

RESULTS

The radiographs and diffraction-enhanced peak images revealed regions of atelectasis in the injured rat lung. The diffraction-enhanced peak images revealed the full extent of the lung with improved clarity relative to the chest radiographs, especially in the portion of the lower lobe that extended behind the diaphragm on the anteroposterior projection.

CONCLUSIONS

For a rat model of gastric acid aspiration, DEI is capable of distinguishing between a healthy and an injured lung and more clearly than radiography reveals the full extent of the lung and the lung damage.

Characterization of an x-ray phase contrast imaging system based on the miniature synchrotron MIRRORCLE-6X

PURPOSE

The implementation of in-line x-ray phase contrast imaging (PCI) for soft-tissue patient imaging is hampered by the lack of a bright and spatially coherent x-ray source that fits into the hospital environment. This article provides a quantitative characterization of the phase-contrast enhancement of a PCI system based on the miniature synchrotron technology MIRRORCLE-6X.

METHODS

The phase-contrast effect was measured using an edge response of a plexiglass plate as a function of the incident angle of radiation. We have developed a comprehensive x-ray propagation model based on the system's components, properties, and geometry in order to interpret the measurement data. Monte-Carlo simulations are used to estimate the system's spectral properties and resolution.

RESULTS

The measured ratio of the detected phase-contrast to the absorption contrast is currently in the range 100% to 200%. Experiments show that with the current implementation of the MIRRORCLE-6X, a target smaller than 30-40 μm does not lead to a larger phase-contrast. The reason for this is that the fraction of x-rays produced by the material (carbon filament and glue) that is used for mounting the target in the electron beam is more than 25% of the total amount of x-rays produced. This increases the apparent source size. The measured phase-contrast is at maximum two times larger than the absorption contrast with the current set-up.

CONCLUSIONS

Calculations based on our model of the present imaging system predict that the phase-contrast can be up to an order of magnitude larger than the absorption contrast in case the materials used for mounting the target in the electron beam do not (or hardly) produce x-rays. The methods described in this paper provide vital feedback for guiding future modifications to the design of the x-ray target of MIRRORCLE-type system and configuration of the in-line PCI systems in general.

Experimental study on phase-contrast imaging with synchrotron hard X-ray for repairing osteonecrosis of the femoral head

Synchrotron radiation light is 1 of 4 artificial light sources, the others being electric light, X-ray, and laser. Phase-contrast imaging with hard X-ray has achieved wide application in many scientific fields, such as biomedicine and material science. This article compares the effectiveness of nanohydroxyapatite/collagen (nHAC) and autologous mesenchymal stem cell for the repair of defects in a rabbit model with osteonecrosis of the femoral head under the monitoring of phase-contrast imaging with synchrotron hard X-ray. We established models of bilateral osteonecrosis of the femoral head defect using New Zealand rabbits and divided them into 3 groups. Imaging techniques such as phase-contrast imaging and diffraction enhanced imaging with synchrotron hard X-ray were applied to assess the degradation and repair process of nHAC and mesenchymal stem cell at 4, 8, and 12 weeks postoperatively. We found phase-contrast imaging with synchrotron hard X-ray displayed the reparative process of the bone defect, degradation of nHAC, and osteocyte substitution. There were significant differences in the repair of the bone defect and osteogenesis in groups B and C compared with group A (control). Osteogenesis was more significant in group C. We provided experimental data for the development and application of synchrotron hard X-ray imaging techniques and concluded that phase-contrast microimaging with synchrotron hard X-ray displays the reparative process of bone tissue at a micro-level and plays an important role in the development of tissue engineering.

Effects of signal diffusion on x-ray phase contrast images

We discuss the problem of signal diffusion among neighbouring pixels in x-ray phase contrast imaging (XPCi) specifically for coded-aperture (CA) XPCi, but many of the discussed observations are directly transferable to other XPCi modalities. CA XPCi exploits the principle of pixel edge illumination by means of two CA masks. The first mask, placed in contact with the detector, creates insensitive regions between adjacent pixels; the second one, placed immediately before the sample, creates individual beams impinging on the boundaries between sensitive and insensitive regions on the detector, as created by the detector mask. In this way, edge illumination is achieved for all pixels of an area detector illuminated by a divergent and polychromatic beam generated by a conventional source. As the detector mask redefines the resolution properties of the detector, sample dithering can be used to effectively increase the system spatial resolution, without having to apply any post-processing procedure (e.g., deconvolution). This however creates artifacts in the form of secondary fringes (which have nothing to do with phase-related secondary fringes) if there is signal diffusion between adjacent pixels. In non-dithered images, signal diffusion between adjacent pixels causes a reduction in image contrast. This effect is investigated both theoretically and experimentally, and its direct implications on image quality are discussed. The interplay with the sample positioning with respect to the detector pixel matrix, which also has an effect on the obtained image contrast, is also discussed.

In vivo x-ray phase contrast analyzer-based imaging for longitudinal osteoarthritis studies in guinea pigs

Over the last two decades phase contrast x-ray imaging techniques have been extensively studied for applications in the biomedical field. Published results demonstrate the high capability of these imaging modalities of improving the image contrast of biological samples with respect to standard absorption-based radiography and routinely used clinical imaging techniques. A clear depiction of the anatomic structures and a more accurate disease diagnosis may be provided by using radiation doses comparable to or lower than those used in current clinical methods. In the literature many works show images of phantoms and excised biological samples proving the high sensitivity of the phase contrast imaging methods for in vitro investigations. In this scenario, the applications of the so-called analyzer-based x-ray imaging (ABI) phase contrast technique are particularly noteworthy. The objective of this work is to demonstrate the feasibility of in vivo x-ray ABI phase contrast imaging for biomedical applications and in particular with respect to joint anatomic depiction and osteoarthritis detection. ABI in planar and tomographic modes was performed in vivo on articular joints of guinea pigs in order to investigate the animals with respect to osteoarthritis by using highly monochromatic x-rays of 52 keV and a low noise detector with a pixel size of 47 × 47 µm(2). Images give strong evidence of the ability of ABI in depicting both anatomic structures in complex systems as living organisms and all known signs of osteoarthritis with high contrast, high spatial resolution and with an acceptable radiation dose. This paper presents the first proof of principle study of in vivo application of ABI. The technical challenges encountered when imaging an animal in vivo are discussed. This experimental study is an important step toward the study of clinical applications of phase contrast x-ray imaging techniques.

Diffraction-enhanced radiography of various mouse organs

OBJECTIVE

The purposes of this study were to evaluate whether a novel radiographic technique, diffraction-enhanced radiographic imaging, would render high-contrast images of mouse livers, hearts, and kidneys and to determine whether blood vessels and bile ducts can be differentiated on images of mouse livers.

MATERIALS AND METHODS

For imaging of the bile ducts, mouse livers were excised 20 or 35 days after ligation of the common bile duct. Livers, hearts, and kidneys of control mice also were excised for imaging. The diffraction-enhanced imaging experiments were performed with a silicon 333 crystal diffraction plane and an 18-keV x-ray beam. The beam incident to the sample measured 20 mm (horizontal) x 11 mm (vertical). Images were acquired with the analyzer crystal set at different positions of the rocking curve.

RESULTS

Only dilated bile ducts, no normal bile ducts, were found. With diffraction-enhanced imaging without a contrast agent, the blood vessels of the liver, heart, and kidney were visualized to a scale of tens of micrometers.

CONCLUSION

Diffraction-enhanced imaging with a silicon 333 crystal plane had excellent contrast in the detection of blood vessels and pathologically dilated bile ducts and may be a promising radiographic technique for basic medical research.

X-ray phase sensitive imaging methods: basic physical principles and potential medical applications

Phase sensitive imaging theoretically allows for a drastic reduction in x-ray dose while simultaneously achieving comparable or better spatial and contrast resolution compared to traditional x-ray absorption based imaging. Several techniques exist to extract the phase information from an x-ray signal, including x-ray interferometry, diffraction enhanced imaging, in-line holography, coded aperture x-ray imaging, and grating-based interferometry. The physics of each method is reviewed, along with the potential clinical applications.

Effect of breast compression on lesion characteristic visibility with diffraction-enhanced imaging

RATIONALE AND OBJECTIVES

Conventional mammography can not distinguish between transmitted, scattered, or refracted x-rays, thus requiring breast compression to decrease tissue depth and separate overlapping structures. Diffraction-enhanced imaging (DEI) uses monochromatic x-rays and perfect crystal diffraction to generate images with contrast based on absorption, refraction, or scatter. Because DEI possesses inherently superior contrast mechanisms, the current study assesses the effect of breast compression on lesion characteristic visibility with DEI imaging of breast specimens.

MATERIALS AND METHODS

Eleven breast tissue specimens, containing a total of 21 regions of interest, were imaged by DEI uncompressed, half-compressed, or fully compressed. A fully compressed DEI image was displayed on a soft-copy mammography review workstation, next to a DEI image acquired with reduced compression, maintaining all other imaging parameters. Five breast imaging radiologists scored image quality metrics considering known lesion pathology, ranking their findings on a 7-point Likert scale.

RESULTS

When fully compressed DEI images were compared to those acquired with approximately a 25% difference in tissue thickness, there was no difference in scoring of lesion feature visibility. For fully compressed DEI images compared to those acquired with approximately a 50% difference in tissue thickness, across the five readers, there was a difference in scoring of lesion feature visibility. The scores for this difference in tissue thickness were significantly different at one rocking curve position and for benign lesion characterizations. These results should be verified in a larger study because when evaluating the radiologist scores overall, we detected a significant difference between the scores reported by the five radiologists.

CONCLUSIONS

Reducing the need for breast compression might increase patient comfort during mammography. Our results suggest that DEI may allow a reduction in compression without substantially compromising clinical image quality.

Articular cartilage imaging by the use of phase-contrast tomography in a collagen-induced arthritis mouse model

RATIONALE AND OBJECTIVES

This study was designed to demonstrate the feasibility of the use of phase-contrast computed tomographic (CT) imaging for the identification of articular cartilage abnormalities of the knees in a mouse model of collagen-induced arthritis.

MATERIALS AND METHODS

Arthritis was induced in nine male DBA/1 J mice by the intradermal injection of collagen. After 50 days, the nine mice were sacrificed, along with four mice that did not receive intradermal injections of collagen. Phase-contrast CT imaging using a microfocus x-ray source of the entire knee was performed. The images were evaluated by two blinded readers, and histopathologic grades were considered the reference standard. The phase-contrast CT images of cartilage were graded 0, I, or II. Evaluation of the grading agreement between the phase-contrast CT images and histopathologic findings was performed using correlation analysis.

RESULTS

Phase-contrast CT images highly reflected the subchondral bone status in the assessment of articular cartilage abnormalities in the mouse model of collagen-induced arthritis. Three-dimensional reformed images showed the articular surface and subchondral bony status of the knee joints. On the basis of the histopathology of the 26 knee joints, 12 joints were grade 0, six joints were grade I, and eight joints were grade II. Grading agreement between the use of the phase-contrast CT images and histopathologic results was high (r = 0.76).

CONCLUSIONS

Phase-contrast CT imaging using a microfocus x-ray source offers a promising tool for the assessment of articular cartilage abnormalities of the knees in a mouse model.